EUS-guided pancreatic duct drainage: a single-center observational study

Abstract

Background and Aims

Pancreatic duct obstruction can cause pain and atrophy of the pancreatic parenchyma. Endoscopic drainage is the first-line treatment, usually by means of ERCP. However, in some patients, the classic transpapillary approach cannot be performed owing to anatomic inability to access the papilla, rupture of the main pancreatic duct, intracanal stones that cannot be crossed, or tight stenosis of the main pancreatic duct due to extrinsic compression by parenchymal calcifications. EUS-guided pancreatic duct drainage is an efficient and minimally invasive therapeutic alternative for these patients. We aimed to evaluate clinical success of EUS-guided pancreatic duct drainage in our center.

Methods

Data of patients who underwent EUS-guided pancreatic duct drainage in our center from 2016 to 2022 were retrospectively reviewed. Clinical success was defined as pain ≤2 on the pain visual analog scale (VAS; 0-10) and no recurrence of obstructive pancreatitis after successful stent placement. If the indication for the procedure was chronic pancreatitis with painless weight loss, then clinical success was defined as weight stabilization or weight regain after the procedure.

Results

Forty-six patients (mean age 58 years, 69.6% male) were included. One indication of EUS-guided pancreatic duct drainage was chronic pancreatitis in 69.6% of patients (78.1% due to alcohol abuse). Other indications included postoperative adverse events, rupture of pancreatic duct, and pancreatic cancer. Technical success was achieved in 93.5% of patients. Forty patients had pancreaticogastrostomy and 3 patients pancreaticoduodenostomy. The mean hospital stay was 2 days. Clinical success was 93% in patients who achieved technical success. Remaining pain (VAS >2) occurred in 9.3% of patients and obstructive pancreatitis recurrence in 6.9%. Adverse events occurred in 5 patients (11.6%). Eighteen stent dysfunctions, 16 stent migrations, and 2 stent obstructions were observed. No patients died from the procedure.

Conclusions

EUS-guided pancreatic duct drainage showed a high clinical success rate. It is therefore a good minimally invasive alternative to avoid pancreatic surgery in patients with symptomatic pancreatic duct stenosis of benign or malignant etiology who failed ERCP.